Use Of Noninvasive Mechanical Ventilation Research Articles

Evidence of non-invasive ventilation in Acute Pulmonary Edema: an integrative review

Introduction: Acute pulmonary edema is a multifactorial clinical syndrome in which there is accumulation of fluid in the pulmonary interstitium and alveolar spaces. It is considered a clinical emergency and one of the main causes of hospitalization, represents one of the main causes of hypoxemic acute respiratory failure, and its severity will depend on the amount of fluid accumulated in the lungs. Initially, when the individual has lower accumulations, he/she will present aquidyspnea, shorthand, and bilateral basal stumour in pulmonary auscultation. Objective: To verify in the literature the existence of evidence of the use of non-invasive mechanical ventilation in the reversibility of acute pulmonary edema. Metodhology: Through the 6 phases of the integrative review, we were able to organize the research in a way that is understandable and accessible so that the data are used as evidence in clinical practice. In order to answer the question presented for the review, bibliographic research of publications indexed in the following databases was performed: MEDLINE/PubMed, Web of Science and Scopus. Results: A total of 1,584 studies were found in the databases, with only 3 articles being included in the discussion because they better answered the research question. Conclusion: On the available literature, it is suggested that therapy may benefit patients with cardiogenic pulmonary edema, and that a greater number of studies may elucidate the best treatment of individuals affected by the disease using non-invasive ventilation as a more assertive resource.

Comparative analysis of clinical features of lower respiratory tract infection with respiratory syncytial virus and influenza virus in adults: a retrospective study

BackgroundRespiratory syncytial virus (RSV) infection in adults remains less recognized and understood, both socially and clinically, compared to influenza virus infection. This retrospective study aims to delineate and compare the clinical manifestations of adult RSV and influenza virus infections in the lower respiratory tract, thereby enhancing awareness of RSV lower respiratory tract infection and providing strategic insights for its prevention and treatment.MethodsClinical data from January 2019 to December 2020 were analyzed for 74 patients with RSV and 129 patients with influenza A/B virus lower respiratory tract infections who were admitted to respiratory or intensive care units. All patients had complete clinical data with positive IgM and negative IgG viral antibodies. Comparison parameters included onset timing, baseline data, clinical manifestations, supplementary examination results, treatment methods, and prognosis, while logistic regression was employed to ascertain the correlation of clinical features between the two patient groups.ResultsIn comparison to the influenza group, the RSV group presented less frequently with fever at admission but exhibited a higher incidence of dyspnea and wheezing on pulmonary auscultation (P < 0.01). RSV infection was more prevalent among patients with underlying diseases, particularly chronic obstructive pulmonary disease (COPD) and demonstrated a higher probability of co-infections, most notably with Mycoplasma (P < 0.01). The RSV group had significantly higher lymphocyte counts (P < 0.01) and exhibited more incidences of pleural thickening, pulmonary fibrosis, and emphysema (P < 0.05). The use of non-invasive mechanical ventilation was more common, and hospital stays were longer in the RSV group compared to the influenza group (P < 0.05). Logistic multivariate regression analysis further revealed that age and tachypnea incidence were significantly higher in the RSV group (P < 0.05).ConclusionCompared to influenza virus infection, adults with COPD are more susceptible to RSV infection. Moreover, RSV infection elevates the risk of co-infection with Mycoplasma and may lead to conditions such as pleural thickening, pulmonary fibrosis, and emphysema. The requirement for non-invasive mechanical ventilation is higher in RSV-infected patients, who also tend to have longer hospital stays. Therefore, greater awareness and preventive strategies against RSV infection are imperative.

The Use of High-Flow Nasal Cannula and Non-Invasive Mechanical Ventilation in the Management of COVID-19 Patients: A Prospective Study.

High-flow nasal cannula (HFNC) and ventilator-delivered non-invasive mechanical ventilation (NIV) were used to treat acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia, especially in low- and middle-income countries (LMICs), due to lack of ventilators and manpower resources despite the paucity of data regarding their efficacy. This prospective study aimed to analyse the efficacy of HFNC versus NIV in the management of COVID-19 ARDS. A total of 88 RT-PCR-confirmed COVID-19 patients with moderate ARDS were recruited. Linear regression and generalized estimating equations (GEEs) were used for trends in vital parameters over time. A total of 37 patients were on HFNC, and 51 were on NIV. Patients in the HFNC group stayed slightly but not significantly longer in the ICU as compared to their NIV counterparts (HFNC vs. NIV: 8.00 (4.0-12.0) days vs. 7.00 (2.0-12.0) days; p = 0.055). Intubation rates, complications, and mortality were similar in both groups. The switch to HFNC from NIV was 5.8%, while 37.8% required a switch to NIV from HFNC. The resolution of respiratory alkalosis was better with NIV. We conclude that in patients with COVID-19 pneumonia with moderate ARDS, the duration of treatment in the ICU, intubation rate, and mortality did not differ significantly with the use of HFNC or NIV for respiratory support.

The use of non-invasive mechanical ventilation in patients with COVID-19: an integrative review

The use of non-invasive mechanical ventilation in patients with COVID-19: an integrative review

P89: The Impact of Symptoms Duration and Management of COVID-19 Associated Severe Acute Respiratory Distress Syndrome on the Venovenous Extracorporeal Membrane Oxyanion Outcomes

Background: veno-venous extracorporeal membrane oxygenation (V-V ECMO) is well established supportive intervention for patients with coronavirus 2019 severe acute respiratory distress. It is unclear if the duration of symptoms and noninvasive and invasive mechanical ventilation before ECMO might impact the clinical outcomes. Methods: We examined COVID-19 patients supported for severe acute respiratory distress syndrome (ARDS) by V-V ECMO at a quandary care institution. The study period was extended from April 1, 2020, to January 1, 2021. Results: Forty-six patients with confirmed COVID-19 were included in our analysis. The mean age was 44.83 +/- 10.46 years old, and the majority were males (63%). 54.3% of COVID-19 patients supported by V-V ECMO survived hospital discharge. The univariant hazards ratio (HR) showed that the prolonged duration of COVID-19 symptoms before initiating ECMO reduced the chance of hospital discharge (HR = 0.932, 95% CI = 0.878-0.99, p = 0.023). Despite not being statistically significant, the longer the duration of the non-invasive mechanical ventilation, the lower the chance of hospital discharge for ECMO patients (HR = 0.895, 95% CI = 0567-1.415, p = 0.636). However, the use of intravenous steroids led to increased hospital discharge, albeit the result remains statistically insignificant (HR =1.545, 95% CI = 0.621-3.846, p = 0.35). Conclusion: Duration of the COVID-19 symptoms and the extended use of non-invasive mechanical ventilation could be associated with poor outcomes for patients supported by V-V ECMO.

Trends in hospital admissions among children with asthma in Spain (2011–2020)

The purpose of this study is to describe and assess changes in incidence, clinical conditions, use of mechanical ventilation, length of hospital stay (LOHS), and in-hospital mortality (IHM) among children hospitalized with asthma in Spain from 2011 to 2020. We analyzed children aged 0 to 15 years hospitalized with an ICD code for asthma included in the Spanish National Hospital Discharge Database (SNHDD). The analysis was conducted for asthma as the primary diagnosis and with asthma in any diagnosis position. Joinpoint regression was used to assess time trends in incidence. We included a total of 85,664 children hospitalized with asthma; of these, 46,727 (54.55%) had asthma coded as the primary diagnosis. The number of boys was higher than the number of girls, irrespective of age group or diagnostic position. The frequency of asthma as primary diagnosis decreased from 55.7% in 2011 to 43.96% in 2020 (p < 0.001). The incidence of hospitalizations because of asthma decreased significantly from 2011 to 2020, with a faster decrease from 2018 onwards. Over time, the proportion of older children increased. In the year 2020, only 55 children had codes for asthma and COVID-19 in their discharge report, and this infection had no effect on hospitalizations this year. A significant increase in the use of non-invasive ventilation (NIV) was observed over time. Irrespective of the diagnostic position, LOHS and IHM remained stable over time, with the IHM under 0.1%. Conclusion: Our results show a decrease in the incidence of hospital admissions with asthma either as the primary diagnosis or in any position. The age of children hospitalized seems to be increasing as the use of NIV. Better management of the disease from primary care and the emergency department as is the use of NIV could explain the reduction in incidence.What is Known:• Asthma is the most common chronic respiratory in childhood in high income countries.• The incidence of hospital admissions with asthma and associated factors is one of the best sources of information on morbidity trends and prognosis.What is New:• The incidence of hospital admissions for asthma in Spain decreased in children between 2011 and 2020 with a more frequent use of non-invasive mechanical ventilation and low mortality rates.• COVID-19 did not cause an increase in admissions with asthma in the year 2020.

Discussion Guide for the van Nieuw Amerongen Article.

Discussion Guide for the van Nieuw Amerongen Article.

NONINVASIVE MECHANICAL VENTILATION IN COVID-19 RELATED ACUTE RESPIRATORY FAILURE.

Coronavirus disease 2019 (COVID-19) is presented with a wide range of symptoms, from asymptomatic disease to severe and progressive interstitial pneumonia. As part of interstitial pneumonia, respiratory failure is typically presented as hypoxia and is the most common cause of hospitalization. When oxygen therapy fails, continuous positive airway pressure (CPAP) or noninvasive mechanical ventilation (NIV) are used as respiratory support measures of first choice. Noninvasive respiratory support (NIRS) is applied in order to save intensive care unit resources and to avoid complications related to invasive mechanical ventilation. Emerging evidence has shown that the use of CPAP or NIV in the management of acute hypoxemic respiratory failure in COVID-19 reduces the need for intubation and mortality. The advantage of NIRS is the feasibility of its application on wards. NIV could be administered via a face mask or helmet interface. Helmet adheres better than mask and therefore leakage is reduced, a delivery of positive end-expiratory pressure is more accurate, and the risk of nosocomial transmission of infections is lowered. Patients on NIRS must be carefully monitored so that further respiratory deterioration is not overlooked and additional measures of care including timely intubation and invasive mechanical ventilation could be performed if needed.

18: EPIDEMIOLOGY OF NONINVASIVE AND INVASIVE MECHANICAL VENTILATION USE FOR CHILDREN AT THE END OF LIFE

Introduction: Invasive mechanical ventilation (IMV) is an intensive intervention commonly experienced by children at the end of life. Non-invasive mechanical ventilation (NIV) is a potential alternative to IMV, and studies have shown increasing use of NIV without decreasing IMV for adults. The objective was to describe the trends, predictors, and hospital variability in use of NIV and IMV for children at the end of life. Methods: Multi-center retrospective cohort study of children 0 to 21 years who died in 1 of 37 hospitals in Pediatrics Health Information Systems (PHIS) Database between 2010 and 2019. ICD-9, ICD-10, and CTC codes were used to identify mode of ventilation (IMV, NIV, both or none). Descriptive statistics summarized socio-demographic and clinical characteristics by mode of ventilation, and hospital NIV use quartiles were calculated. The Cochran-Armitage test assessed for trends over time and multivariable random-effect logistic regression assessed for independent predictors of ventilatory support. Results: 41,091 patients (median age 0.4, IQR [0,6.7] y, 45% female, 42% white) died in the hospital. Increasing age predicted lower odds of IMV (aOR .95 per year, 95% CI .95-.96, p<.001) or both (aOR .98 per year, 95% CI .97-.99, p=.005) compared to none. Number of complex chronic conditions (CCC) (median [IQR]) was 2 [1,3] overall and for IMV, 3 [2,3] for NIV, and 3 [2,4] for both. Self-pay patients were less likely than commercially or government insured to receive IMV (aOR .69, 95% CI .56-.84, p<.001) or both (aOR .37, 95% CI .27-.5, p<.001). From 2010 to 2019, exposure to NIV increased (771 [18.8%] vs. 1075 [25.9%], p<.001) with no change in IMV (3636 [88.6%] vs. 3669 [88.5%], p=.86); increase in NIV was more often experienced as both (688 [16.8%] vs. 944 [22.8%]) than NIV (83 [2%] vs. 131 [3.2%]). For hospitals in the highest NIV use quartile, the aOR for any NIV was 6.16 (95% CI 3.98-9.52, p<.001) and any IMV was .8 (95% CI .55-1.17, p=.249) compared to the lowest NIV use quartile. Conclusions: Use of NIV has increased over time for children nearing the end of life, without a reciprocal decrease in use of IMV. Differences exist based on age, insurance status, and chronic medical complexity. Significant interhospital variability in NIV use exists, which does not correlate with use of IMV.

Severe community-acquired pneumonia.

Severe community-acquired pneumonia is the most life-threatening form of community-acquired pneumonia, characterised by intensive care unit admission and high morbidity and mortality. In this review article, we cover in depth six aspects of severe community-acquired pneumonia that are still controversial: use of PCR molecular techniques for microbial diagnosis; the role of biomarkers for initial management; duration of treatment, macrolides or quinolones in the initial empirical antibiotic therapy; the use of prediction scores for drug-resistant pathogens to modify initial empiric therapy; the use of noninvasive mechanical ventilation and high-flow nasal oxygen; and the use of corticosteroids as adjunctive therapy in severe community-acquired pneumonia.

Nebulización con malla vibratoria de Agonistas β 2 y anticolinérgicos a través de cánula nasal de alto-flujo durante la exacerbación de EPOC: Serie de casos

It is estimated that more than 2.3 million Argentineans suffer from Chronic Obstructive Pulmonary Disease (COPD) with a high rate of underdiagnosis and misdiagnosis. Pharmacological treatment with bronchodilators (BD) is the primary treatment and in cases of severe exacerbation the use of non-invasive mechanical ventilation (NIV) is recommended with a high level of evidence in patients with hypercapnia. High-flow nasal cannula (HFNC) has been postulated as an alternative to NIV in case of intolerance to interfaces or as a rest period bridge during times without NIV. HFNC is increasingly being used in patients with exacerbated COPD as an alternative to conventional oxygen therapy ( COT) and even as combined therapy in patients with NIV. Therefore, the administration of BD through HFNC may be relevant for the treatment of patients with exacerbated COPD.

Unusual complications of non-invasive mechanical ventilation (NIV) and high-flow nasal cannula (HFNC): A systematic review.

The first application of modern non-invasive mechanical ventilation (NIV) can be traced back to over 30 years ago when a patient suffering from Duchenne Muscular Dystrophy was successfully ventilated. Since then, the use of NIV has been on the rise throughout the world. Although a very modern and safe therapy, complications during its application are inevitable. In addition to some well-known complications, others have described more rare entities. In this article, we described such rare complications as pneumoperitoneum, pneumocephalus, parotitis, gastric perforation, and barotrauma. The purpose of this review was to describe unusual complications of NIV, their prevalence, and the mechanisms by which such complications arise. We performed a clinical review by searching PubMed, Embase, and Cochrane libraries with Mesh terms: 'non-invasive mechanical ventilation', 'high-flow nasal cannula', 'rare complication', 'unusual complication', and 'unexpected complication'. These terms were cross-referenced with other keywords: 'pneumoperitoneum', 'parotitis', 'pneumocephalus', 'gastric insufflation', and 'barotrauma'. We included 26 research papers. When applying mechanical ventilation, it is necessary to have a strong knowledge of the mechanics of the device as well as familiarity with the complications that may occur during its use, including less common ones. Prompt and effective treatment of such complications is required, as well as careful consideration of the potential causes of such events, during the application of NIV or HFNC.

Embolic versus non- embolic acute coronary syndrome. Prognosis differences

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Coronary embolism (CE) is a rare cause of acute coronary syndrome with current evidence from small case series. In our previous work (n=36), atrial fibrillation was the main risk factor and STEMI the most frequent presentation. Objetives In this analysis we compare severity characteristics, management and in-hospital prognosis between an embolic cohort versus a non-embolic one among patients with left anterior descending artery as culprit vessel. Methods Observational, retrospective descriptive study of patients admitted in our unit from July 2011 to march 2021 for ACS. The diagnosis of CE was established according to the National Cerebral Cardiovascular Center Criteria. Data were obtained from the ARIAM Andalucia Registry. Results 646 Patients were analysed (19 embolic vs 627 non-embolic). There were no differences in ejection fraction (EF) (43±9% vs 44±10%, p&amp;gt;0.05) or Killip-Kimbal (KK) stage at admission moment (stage I more frequent in both groups) or use of inotropes or vasoactive drugs. Embolic cohort had more in-hospital complications: worse KK stage (p=0.001; KKII 23.5% vs 15.3%; KKIII 23.5% vs 5.9%), more thrombocytopenia (5.3% vs 0.8%, p=0.046) and higher hsTnT levels (p=0.000). There was more use of non-invasive mechanical ventilation in embolic group (21.1% vs 4.9%, p=0.002). Without differences in incidence of cardiac arrest, mechanical complications, bradycardia, hemorrhage or in-hospital dead. Conservative management was more frequent in the embolic group. Percutaneous coronary intervention was the most frequent strategy in both cohorts (14.3% vs 3%; 85.6% vs 92.3%; p&amp;lt;0.05). At discharge, there were not significant differences in antithrombotic or anticoagulant therapy. Conclusions In our series the embolic group had worse KK stage and more need of non-invasive mechanical ventilation. They had no significant differences in EF, other mayor complications nor in-hospital mortality.

Renal recovery after acute kidney injury in a minority population of hospitalized COVID-19 patients: A retrospective cohort study.

This study aimed to characterize survivors of Coronavirus disease 2019 (COVID-19) infection and acute kidney injury (AKI) that recover their renal function or progress to acute kidney disease (AKD) on discharge; and determine factors associated with progression to AKD during hospital stay.One thousand seventy four patients with COVID-19 infection were followed up until discharge/death. The incidence of AKI was 59.7%. Two hundred and sixty-six patients were discharged alive and included in the analysis, 71.8% had renal recovery (RR) while 28.2% were discharged with AKD. The AKD subset has higher rate of chronic kidney disease (CKD) ≥3 (33.4% vs 14.1%, P = .001), congestive heart failure (18.7% vs 5.8%, P = .001), use of non-invasive mechanical ventilation (10.7% vs 3.7%, P = .026) and vasopressors (25.3% vs 12.0%, P = .007). Of 19 patients in the AKI survivor cohort who received renal replacement therapy, 1 had RR while 18 progressed to AKD on discharge. Predictors to progression to AKD were CKD ≥3 (Odds Ratio [OR]: 3.23, 95% confidence interval [CI] 1.59-6.56, P = .001), congestive heart failure (OR: 4.59, 95% CI 1.76-11.78, P = .002), AKI on admission (OR: 2.71, 95% CI, 1.14-6.46, P = .025), and ongoing diarrhea (OR: 3.19, 95% CI, 1.02-9.96, P = .025).This study demonstrates a higher proportion of RR among survivors of COVID-19 infection in our minority predominant cohort. Early identification and appropriate management of patients at-risk to progress to AKD could improve outcomes, reduce long term sequalae of CKD/end stage renal disease, and have a major impact on health outcome and financial strain on healthcare system.

Noninvasive or Invasive Mechanical Ventilation in Oncohematologic Patients with Acute Respiratory Failure: A Systematic Review and Meta-Analysis

Background: Acute respiratory failure (ARF) in oncohematologic subjects is one of the most common causes of high mortality rates. Noninvasive mechanical ventilation (NIMV) has arisen as an accessory treatment in this clinical scenario. Objective: This study aimed to compare mortality rates and severity of illness associated with NIMV or invasive mechanical ventilation (IMV) in oncohematologic patients with ARF. Methods: A search was conducted in the PubMed, SCOPUS, Cochrane Library, LILACS, Web of Science, and gray literature databases, published between November 2007 and May 2021. Results: Eight studies with a total of 570 patients were included. Patients with good responses to NIMV showed lower values of the Simplified Acute Physiology Score III (SAPS 3) (range: 42±7 to 53±17) when compared to those intubated following NIMV failure (range: 50±11 to 63.3±17.4) and those who underwent IMV as the primary ventilator support (range: 64.9±17.5 to 66±17). Similarly, patients whose NIMV treatment failed and those that initially used IMV had higher baseline values of Sequential Organ Failure Assessment Score (SOFA) when compared to the group with a good response to NIMV. ICU mortality ranged from 40% to 68% in NIMV success, 54% to 79% in NIMV failure, and from 54% to 80% in the group treated with IMV. NIMV therapy had a significant protective effect on mortality (RR=0.71, 95% CI: 0.53-0.94, p=0.02). Conclusions: NIMV use in oncohematologic patients admitted to the intensive care units (ICU) with ARF was associated with lower mortality. Patients successfully treated in the NIMV group showed lower values of SOFA and SAPS 3 (Prospero Systematic Review -protocol number: 132770).

Low Eosinophil Phenotype Predicts Noninvasive Mechanical Ventilation Use in Patients with Hospitalized Exacerbations of COPD.

RationaleEosinophilic inflammation is related to the progression and outcomes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Till now, few studies have focused on low EOS in AECOPD.ObjectiveTo reveal the clinical characteristics, therapeutic responses and prognosis of patients hospitalized of AECOPD with low EOS.MethodsThe electronic database of Zhongshan Hospital, Fudan University was used. Cohort 1 included 608 patients with hospitalized AECOPD. Study population 2 consisted of 166 patients with AECOPD admission at least twice. Impact of low EOS on NIMV treatment, length of hospital stays and 12-month AECOPD-related readmission were analyzed with multivariable logistic regression model. Thirty-five hospitalized AECOPD patients were prospectively recruited as cohort 3 to explore the association between EOS and other immune cells using Spearman correlation coefficient for ranked data.ResultsEOS level was suppressed on admission in AECOPD patients, and significantly improved after hospitalized treatment (P < 0.05). For inflammatory markers, leucocytes, neutrophils and lactate dehydrogenase levels were higher, while lymphocytes, monocytes and interleukin-6 levels were lower in the low-EOS group than those in the non-low EOS group (P < 0.05). Low EOS (EOS < 50 cells/μL) was an independent risk factor of NIMV use (OR = 1.86, 95% CI = 1.26 ~ 2.73). The EOS percentage was positively correlated with the T cell percentage (r = 0.46, P < 0.05) and negatively correlated with the natural killer cell percentage (r = −0.39, P < 0.05). The patients with low EOS had lower level of CD4+ T cell (P < 0.05) than that of patients with non-low EOS.ConclusionLow EOS might be a stable phenotype in patients with hospitalized AECOPD and could be used to inform NIMV management, hyperinflammatory state and impaired immunity situation.

Hospital Variation in Non-Invasive Ventilation Use for Acute Respiratory Failure Due to COPD Exacerbation.

BackgroundNon-invasive mechanical ventilation (NIV) use in patients admitted with acute respiratory failure due to COPD exacerbations (AECOPDs) varies significantly between hospitals. However, previous literature did not account for patients’ illness severity. Our objective was to examine the variation in risk-standardized NIV use after adjusting for illness severity.MethodsWe retrospectively analyzed AECOPD hospitalizations from 2011 to 2017 at 106 acute-care Veterans Health Administration (VA) hospitals in the USA. We stratified hospitals based on the percentage of NIV use among patients who received ventilation support within the first 24 hours of admission into quartiles, and compared patient characteristics. We calculated the risk-standardized NIV % using hierarchical models adjusting for comorbidities and severity of illness. We then stratified the hospitals by risk-standardized NIV % into quartiles and compared hospital characteristics between quartiles. We also compared the risk-standardized NIV % between rural and urban hospitals.ResultsIn 42,048 admissions for AECOPD over 6 years, the median risk-standardized initial NIV % was 57.3% (interquartile interval [IQI]=41.9–64.4%). Hospitals in the highest risk-standardized NIV % quartiles cared for more rural patients, used invasive ventilators less frequently, and had longer length of hospital stay, but had no difference in mortality relative to the hospitals in the lowest quartiles. The risk-standardized NIV % was 65.3% (IQI=34.2–84.2%) in rural and 55.1% (IQI=10.8–86.6%) in urban hospitals (p=0.047), but hospital mortality did not differ between the two groups.ConclusionNIV use varied significantly across hospitals, with rural hospitals having higher risk-standardized NIV % rates than urban hospitals. Further research should investigate the exact mechanism of variation in NIV use between rural and urban hospitals.

The success of non-invasive mechanical ventilation in lung cancer patients with respiratory failure.

Despite the improvement in survival among patients with lung cancer as a result of the development of novel treatment options, acute respiratory failure (ARF), which may occur because of the disease itself, comorbidities or complications in treatment may be life threatening. The most commonly utilised treatment option in cancer patients with ARF is invasive mechanical ventilation (IMV). The prognosis of lung cancer patients admitted to the intensive care unit is poor. The use of non-invasive mechanical ventilation (NIMV) in the setting of ARF not only supports the respiratory muscles and facilitates alveolar ventilation and airway patency, but also reduces the risk of serious complications of IMV, such as ventilator-associated pneumonia. NIMV treatment in the event of respiratory failure has been associated with a high rate of mortality in recently diagnosed or progressive lung cancer with organ failure. However, studies in this regard are limited, and the role of NIMV has yet to be investigated in patients in hospital wards. Accordingly, the present study investigates retrospectively the success of NIMV among patients with lung cancer (including all stages and histopathological types) in a hospital ward setting and the influential factors. The data of 42 patients with lung cancer and respiratory failure who were admitted to the palliative care service and received NIMV between 2014 and 2018 were reviewed retrospectively. Demographic features, comorbidities, respiratory failure types, rate of withdrawal from NIMV, frequencies of tracheostomy and intubation, bacteriologic examination of the airway samples, rate of discharge from hospital and any history of NIMV/USOT use at home were recorded. NIMV success was defined as the discharge of the patient from the hospital, with or without a respiratory support device. The primary end-point of the study was NIMV success, while the secondary end-point was NIMV success with respect to the underlying diagnosis and respiratory failure type. A total of 42 patients (38 males and 4 females) were included in the study, with a mean age of 67.4±9.5years. The rate of discharge from hospital was 71% across the entire study population, among which, 13 (31%) were discharged with USOT and 16 (38.1%) with NIMV. Among the 12 patients under palliative supportive treatment, 8 were discharged from the hospital. The success rates of NIMV in the respiratory failure aetiological subgroups were: 66% (12 patients) in the pneumonia subgroup and 71.4% (15 patients) in the COPD subgroup. The difference between these subgroups was not significant (P=.841). The success rate of NIMV in the hypercapnic and hypoxaemic respiratory failure subgroups was 72.7% (24 patients) and 66.6% (6 patients), respectively. There were no significant differences between the type of respiratory failure subgroups (P=.667). The success rate of NIMV was similar in patients with a positive airway sample microbiology (71.4%, n=14) and those with no growth identified in the culture (70.3%, n=28) (P=.834). In lung cancer patients with no contraindication, NIMV can be used to reduce or postpone the need for ICU admission, independent of disease stage, cellular type and underlying cause.

Combined association of obesity and other cardiometabolic diseases with severe COVID-19 outcomes: a nationwide cross-sectional study of 21 773 Brazilian adult and elderly inpatients

ObjectivesTo investigate the combined association of obesity, diabetes mellitus (DM) and cardiovascular disease (CVD) with severe COVID-19 outcomes in adult and elderly inpatients.DesignCross-sectional study based on registry data from Brazil’s...

The Effect of Non-Invasive Mechanical Ventilation on Respiratory and Inflammatory Parameters in Patients with Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is an airway obstructive disease that is often caused by smoking. The disease is currently the third leading cause of death worldwide. The current therapeutic approach is based on Non-Invasive Ventilation (NIV) therapy, which can reduce mortality, the need for hospitalization in the intensive care unit, and to some extent therapeutic complications. Therefore, this study was performed to determine the effect of non-invasive ventilation along with routine treatments on respiratory markers, inflammation, and clinical status of patients with COPD.&#x0D; Methods: A total of 30 patients with COPD referred to Masih Daneshvari Hospital were divided into control and intervention groups. In the intervention group, 15 patients underwent non-invasive ventilation in addition to the usual treatments, and in the control group, the patients underwent only the usual treatments. After completing the mMRC (Modified Medical Research Council) questionnaire and evaluating FEV1 (Forced Expiratory Value in one score), 5 ml of blood samples were taken from these patients at the beginning of the study, on the seventh to tenth day, and also in the third month, and the results of this evaluation were compared between the two groups.&#x0D; Results: Based on the results of this study, the mMRC score of the intervention group was significantly lower than the control group in the first week (p=0.043) and three months after treatment (p=0.049). However, indices such as FEV1, and IL-8(Interleukin-8) did not change significantly in both groups.&#x0D; Conclusion: The use of non-invasive mechanical ventilation along with standard treatments can play a relative role in improving patient outcomes.